Thank you for your participation in the Bioscan Program. Please review each item below and sign your agreement below:
Only proceed if you have completed STEP ONE above.
Electro-acupuncture and stress testing through the Bionetic BioScan® provides an opportunity to measure electrical responses and meridian flows of the body. Bioenergetic evaluation of the energy flow helps identify various stressors that might impede the electrical process. The evaluation may include recommendations for natural remedies, stress reduction methods and/or nutritional changes designed to balance the energy meridians and enhance overall wellness. These recommendations are not cures for any known diseases, nor have they been proven clinically to eliminate any specific disease process. The bioenergetic evaluation is not a method of diagnosing, nor are the suggested remedies designed to replace any of the medications or treatments currently being provided or recommended by a primary care practitioner.
1. I fully understand that the testing consultant is not an allopathic doctor (M.D.) and does not pretend to be, but is a bioenergetic practitioner providing services that are not allopathic, but that are within the parameters of a natural health and wellness philosophy.
2. I fully understand that the testing consultant does not offer allopathic drugs, surgery, chemical stimulants or radiation therapy, but is providing information and natural products to restore natural balance and optimum conditions for health and wellness based on the scope of his/her practice.
3. I fully understand that the consultant is not diagnosing or treating any illness or disease, but is only measuring the bioenergetic balance and overall stress responses of the body, and that these services may not be generally accepted and/or recommended by allopathic physicians or other health professionals.
4. I fully understand that the testing consultant is in no way encouraging me to terminate or modify any previous or ongoing therapies under the direction of any licensed practitioner, and that the testing consultant can/will not dissuade me from seeking allopathic attention, recommendations or modes of therapy from a licensed practitioner.
5. I presently seek consultation, advice, opinions and/or programs, tests, evaluations and/or products within the scope of the testing consultant's wellness practice based upon the principles of bioenergetic health and have solicited the testing consultant's services in good faith, exerting my free will and following the dictates of my own conscience which allows me to select what I understand is most beneficial to my health.
6. I certify this test is for the person stated on the input form. If I am submitting this on behalf of a minor, an incompetent or animal, I give full faith that I am legally and totally responsible for them.
7. I authorize the testing consultant to provide his/her services to me on my behalf, and hereby release him/her from any and all claims and potential claims arising out of my actions or failure to act upon his/her advice. I furthermore, as a client, on this and any subsequent test, act solely on my own behalf and not as an agent for Federal, State, or Local agencies on a mission of entrapment or for any investigative purposes.
8. I give full faith that I have read and understand this document entirely and any questions have been satisfactorily answered by calling BioRenew, LLC at 770-498-2886.
9. I am willing to declare and repeat under oath all of the above statements by request of BioRenew, LLC.
With my typed signature below, I hereby consent to and authorize the above described Bionetic BioScan® analysis and evaluation as it appears at www.biorenew.com/bioscan_release: